Healthcare Provider Details

I. General information

NPI: 1558656751
Provider Name (Legal Business Name): JUNABEL MARIANO PEDRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAIN ST
LIVINGSTON CA
95334-1428
US

IV. Provider business mailing address

1100 PEDRAS RD APT. E221
TURLOCK CA
95382-2363
US

V. Phone/Fax

Practice location:
  • Phone: 209-394-8416
  • Fax:
Mailing address:
  • Phone: 209-669-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: